Herscovici D型内踝骨折内固定方法的个性化选择  

Individualized selection of internal fixation methods for Herscovici’s type D medial malleolus fractures

作　　者：涂俊波 李兴旺[1] 刘旭敏[1] 邹勇[1] 肖太阳[1] 江海翔 TU Jun-bo;LI Xing-wang;LIU Xu-min;ZOU Yong;XIAO Tai-yang;JIANG Hai-xiang(Department of Orthopedics,Xinfeng People's Hospital,Xinfeng,Jiangxi 341600)

机构地区：[1]信丰县人民医院骨科,江西信丰341600

出　　处：《赣南医学院学报》2022年第7期690-696,共7页JOURNAL OF GANNAN MEDICAL UNIVERSITY

摘　　要：目的:观察应用三种不同的内固定方法治疗Herscovici D型内踝骨折的临床疗效。方法:筛选我科2013年1月至2019年6月涉及内踝骨折为Herscovici D型行内固定手术患者,共95例,依据接受固定方式不同分为三组,传统螺钉固定技术组27例,抗滑螺钉组31例,钢板固定组34例。观察切口愈合及感染情况、周围软组织激惹等伤口并发症相关情况及骨折愈合时间,术后3个月骨折复位影像学Burwell-Charnley评价优良率、末次随访记录行走时患侧踝部疼痛视觉模拟(Visual Analogue Scale,VAS)评分及踝-后足评分系统(Ankle Hind foot Scale,AOFAS)评分优良率。结果:三组患者伤口以及骨折愈合相关并发症差异无统计学意义(P>0.05)。钢板组骨折愈合时间较传统螺钉组和抗滑螺钉组短,差异有统计学意义(P<0.05),抗滑螺钉组骨折愈合时间较传统螺钉组短,差异有统计学意义(P<0.05);末次随访患侧踝部VAS评分,钢板组低于传统螺钉组和抗滑螺钉组,传统螺钉组大于抗滑螺钉组,差异均有统计学意义(P<0.05);钢板组VAS评分与抗滑螺钉组差异无统计学意义(P>0.05);在AOFAS评分优良率方面,传统螺钉组优良率均低于抗滑螺钉组及钢板组,差异均有统计学意义(P<0.05),抗滑螺钉组与钢板组比较,差异无统计学意义(P>0.05);传统螺钉组Burwell-Charnley骨折愈合情况评估优良率低于抗滑螺钉组及钢板组,差异均有统计学意义(P<0.05),而抗滑螺钉组与钢板组比较,差异无统计学意义(P>0.05)。结论:抗滑螺钉固定技术及抗滑钢板固定技术均可满足患者术后早期功能锻炼的需求。对于骨质疏松症、骨块较碎、植骨的患者可以考虑钢板联合长螺钉固定,获得更大的加压固定以及抗旋转能力。Objective:To observe the clinical efficacy of three different internal fixation methods in the treatment ofHerscovici’s type D medial malleolar fractures. Methods:A total of 95 patients with Herscovici’s type D medial malleolarfractures undergoing internal fixation in our department from January 2013 to June 2019 were selected. According todifferent internal fixation methods,the patients were divided into traditional screw group(n=27),anti-slip screw group(n=31)and plate fixation group(n=34). The observation indexes included wound complications such as wound healingand infection,surrounding soft tissue irritation,as well as fracture healing time. Three months after surgery,the excellentand good rate of fracture reduction was evaluated by Burwell-Charnley imaging,and the excellent and good rates of VASscore of the affected ankle and AOFAS score of ankle function were recorded at the last follow-up. Results:No statisticallysignificant differences were found in wound and fracture healing-related complications among the three groups(P>0. 05). The fracture healing time of the plate fixation group was shorter than that of the traditional screw group and theanti-slip screw group,with statistically significant differences(P<0. 05). The fracture healing time of the anti-slip screwgroup was shorter than that of the traditional screw group,presenting a statistically significant difference(P<0. 05). At the last follow-up,VAS score of the affected ankle was lower in the plate fixation group than the traditional screw groupand the anti-slip screw group,higher in the traditional screw group than the anti-slip screw group,the differences ofwhich were all statistically significan(tP<0. 05). However,VAS score showed no statistically significant difference(P>0. 05)between the plate fixation group and the anti-slip screw group. As for AOFAS score,the excellent and good rate inthe traditional screw group was lower compared with the anti-slip screw group and the plate fixation group,showing statis-tically significant differences(P

关 键 词：内踝 骨折 Herscovici D型 内固定 

分 类 号：R683.42[医药卫生—骨科学]